An Insight into the Perineum Protection Issue

An intensive use of the bicycle may increase the risk of erectile dysfunction and the compression of the perineal area has been showed to be a major mechanism leading to sexual alterations compromising the quality of life. Manufacturers claim that pads contribute to increase cyclists perineal protection ensuring a high level of comfort. To investigate the influence of various cycling pads with regard to perineal protection and level of comfort. Nine club road cyclists rode 20 min on a drum simulator, located at the Nutrition and Exercise Physiology Laboratory, at a constant speed and gear ratio wearing the shorts with 3 cycling pads of different design and thickness: basic (BAS), intermediate (INT), and endurance (END). Kinematics and pressure data were recorded at min 5, 15, and 20 of the test using a motion capture system and a pressure sensor mat. The variables of interest were: 3-dimensional pelvis excursions, peak pressure, mean pressure, and vertical force. The comfort level was assessed with a ranking order based on the subjects’ perception after the 20-min trials and measuring the vertical ground reaction force under the anterior wheel as well as the length of the center of pressure (COP) trajectory on the saddle. Results showed that the vertical force and the average value of mean pressure on the saddle significantly decreased during the 20-min period of testing for BAS and END. Mean peak pressure on the corresponding perineal cyclist area significantly increased only for BAS during the 20min period. Interestingly objective comfort indexes measured did not match cyclists subjective comfort evaluation. The lower capacity of BAS to reduce the peak pressure on the corresponding perineal area after 20 min of testing, together with its positive comfort evaluation, suggest that a balance between protection and perceived comfort should be taken into account in the choice of the pad. Hence, the quantitative approach of objective comfort indexes introduced in this study could be helpful for manufacturers in the development of their protective pads. (Medicine 94(29):e1186) Abbreviations: BAS = basic, COP = center of pressure, END = endurance, INT = intermediate, TDC = top dead centers, vGRF = vertical component of the ground reaction force. INTRODUCTION A n intensive use of the bicycle can lead to nontraumatic injuries as reported by Dettori and Norvell. In the last few years scientific literature focused on the overuse injuries affecting the genitourinary tract because of their effect on the reduction of cyclists quality of life: mechanical causes of these injuries and countermeasures to reduce the problem are the main topics of researchers. Dettori et al examined the relationship between bicycle characteristics and the occurrence of erectile dysfunction in 463 cyclists who completed a cycling event of at least 320 km. Results showed a cumulative incidence of erectile dysfunction after the ride of 4.2% and of 1.8% 1 week and 1 month after the event. Leibovitch and Mor reported in a review that the most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50% to 91% of the cyclists, followed by erectile dysfunction reported in 13% to 24%. Schrader et al investigated the nocturnal penile tumescence and rigidity in 17 patrol officers riding an average of 5.4 h/day in comparison with 5 nonbiking men. Results showed that the percentage of sleep sessions that recorded an erectile event was significantly lower in the cyclists (27.1%) than it was in noncyclists (42.8%) suggesting that prolonged bicycle riding may have negative effects on nocturnal erectile function. The compression and the stretch of the pudendal nerve near critical points like the ischiatic tuberosities and the pubic arc during pedaling seems to be the cause of both genital numbness and erectile dysfunction. The mechanical pressure leads to transient hypoxemia of the nerve and/or to a primary neuropathic process. The duration of these compressions seems to be more relevant than the amount of the pressure itself. Another possible pathophysiological mechanism of erectile dysfunction in cyclists is due to the compression of the perineal artery with a decrease of the blood flow to the penis and a consequent imbalance between the transforming growth factor beta 1 (TGF-b1) and prostaglandin E (PGE) in favor of TGF-b1 which induces collagen and connective tissue synthesis in the corpus cavernosum. Through examining this problem from a biomechanical point of view Gemery et al proposed a model of the complex saddle/perineum by means of tomography scans of 1 adult male pelvis and 3 bicycle seats. The pelvis/seats model developed by these authors showed that during cycling the most compressed point of the internal pudendal artery was immediately below the pubic symphysis. The mechanical compression of perineum tissue during cycling was also investigated by means of magnetic resonance imaging of the perineal cavernous spaces, where the penile neurovascular tissues are located. This study confirmed the Editor: Antonino Bianco. Received: February 16, 2015; revised: June 11, 2015; accepted: June 25, 2015. From the Department of Biomedical Sciences, University of Padova, Padova, Italy (GM, CR, AP); Department of Industrial Engineering, University of Padova, Padova, Italy (NP); and School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Western Australia, Australia (FAP). Correspondence: Antonio Paoli, Department of Biomedical Sciences, University of Padova, Via Marzolo 3, 35131 Padova, Italy (e-mail: Antonio.paoli@unipd.it). The study was partailly funded by Cytech Srl. The company had no role in the design, conduct, or analysis of the study. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000001186 Medicine®